Research roundup: Unequal 'culture of quality' in hospitals; Peer-support for stressed doctors

Mar 23 2012

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs. 

Archives of Surgery: Comparison Of Hospital Performance In Trauma Vs Emergency And Elective General Surgery –This study compared outcomes of trauma patients and patients having either elective or emergency surgery in the same hospital.  Researchers thought that "hospital performance reflected institutional culture, and, thus, would be similar across all services." But when looking at mortality and morbidity rates at 46 hospitals, they instead determined the "culture of quality" in trauma programs often did not also affect the other programs. They suggested that emergency general surgery departments should be incorporated into trauma performance improvement programs. (Ingraham et. al., 3/19).

Archives of Surgery: Physicians' Needs In Coping With Emotional Stressors -- In a survey given to more than 100 physicians at a large tertiary care academic hospital, the researchers found that 79% of physicians "experienced  either a serious adverse patient event and/or traumatic personal event within the preceding year." Conventional medical training does not generally address this problem and physicians often do not receive support after these events. The authors conclude: "Despite the prevalence of stressful experiences and the desire for support among physicians, established services are underused. As colleagues are the most acceptable sources of support, we advocate peer support as the most effective way to address this sensitive but important issue" (Hu et. al., March 2012).

The Urban Institute: Federal Health Expenditures On Children On The Eve Of Health Reform: A Benchmark For The Future -- This report found that even as the percentage of children in the population declined, the percentage of federal health spending on them has increased from 2 percent 50 years ago to 10 percent in 2010. That growth was fueled by Medicaid and CHIP coverage. "With enrollment in public programs expected to increase dramatically for the adult population in the coming years [under the federal health law], it will be important to monitor access for children who receive care under Medicaid and CHIP to ensure that their critical health and developmental needs are being met," the authors write (Hahn, Kenney, Coyer and Toran, 3/22).

George Washington University/Kaiser Family Foundation: Medicaid And Community Health Centers: The Relationship Between Coverage For Adults and Primary Care Capacity In Medically Underserved Communities -- This report "compares the strength of health centers in states that have expanded Medicaid coverage for adults to health centers in states with more limited Medicaid coverage for adults." The authors noted that community health centers expansion states had higher revenue, more center sites and greater growth in number of patients.  They added that "broader Medicaid eligibility for adults appears to be associated with an enhanced ability of health centers to invest in capacity-building activities to better meet the needs of their patients and communities" (Shin and Rosenbaum, 3/22).

Kaiser Family Foundation/Georgetown University: Key Issues In Understanding The Economic And Health Security Of Current And Future Generations Of Seniors -- This issue brief looks at proposed changes in three major entitlement program – Medicare, Medicaid and Social Security – to determine what effect they would have on seniors: "As policymakers consider options for decreasing spending on entitlement programs, it is important to consider the overall and interrelated effects of policy proposals on seniors' ability to pay for needed health care and essential living expenses. Especially important is recognition of the health and economic vulnerabilities faced by a sizable share of seniors" (Komisar, Cubanski, Dawson and Neuman, 3/19).

Here is a selection of news coverage of other recent research:

KQED's State of Health blog: Trauma Fuels HIV Epidemic Among Women
Now two new studies published in the journal AIDS and Behavior show that HIV-positive women suffer disproportionately high rates of trauma and PTSD. In a vicious circle, the high rates of trauma lead to increased risk of further spreading the illness. ... That combination of skipping medication and unsafe sex leads to alarming public health consequences, says lead author Edward Machtinger, who directs UCSF's Women's HIV Program. He said if a woman isn't taking HIV medications properly, she is more infectious (Kalantari, 3/20). 

MedPage Today: Peer Mentoring Helps Black Diabetics
Talking with diabetic peers who've gotten their blood sugar under control helped other African-American diabetes patients bring down their own levels, researchers found. In a sixth-month intervention among black veterans, those in a peer mentoring program lowered their HbA1c levels more than either those on usual care or those given a financial incentive, Judith Long, MD, of the University of Pennsylvania, and colleagues reported in the March 20 issue of Annals of Internal Medicine (Fiore, 3/20).

WBUR's CommonHealth blog: U.S. Cancer Screening Is Pricey, But With No Better Outcomes Than Public System
A new report comparing cancer screening programs in the U.S. and the Netherlands comes up with this not-so-surprising conclusion: we screen more here -; three to four times more in this case -; but mortality rates are the same in both countries. The analysis of cervical cancer screening programs, published in the Milbank Quarterly ... [found that] Not only does the publicly-run system focus on prevention, but it appears to implement its prevention plan in a way that saves money without undermining care (Zimmerman, 3/20).

MedPage Today: Only a Feel-Good Effect From More Dialysis
More frequent dialysis may make patients feel better, but it has no effect on objective physical performance, researchers reported.  In two randomized trials, there was some evidence that self-reported health and physical functioning were better after a year of dialysis six times a week rather than three, according to Yoshio Hall, MD, of the University of Washington in Seattle, and colleagues. But on three measures of physical ability to stand up, walk, and balance, there was no difference, Hall and colleagues reported online in the Clinical Journal of the American Society of Nephrology (Smith, 3/19).

Chicago Sun-Times: Study: Hospitals Can Speed Mental Decline For Elderly
Hospitalizing older people might place them at higher risk for accelerated cognitive decline, according to a Rush University study released Wednesday. Rates of decline occurred twice as fast among elderly patients on average after a hospital stay compared with their previous rate of decline and with older people not admitted to a health care facility. Some mental change is considered a normal part of aging, but advanced decline is associated with risk of disability and loss of independence, dementia and death (Lloyd, 3/21).